Saginaw Valley State University Request for Reasonable Accommodation

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* First Name

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* Last Name

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* Work Phone Number

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* Home Phone Number

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* Email

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* Position

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* Department

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* Employment Status

Full Time

Part Time

Student Employee

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* Supervisor / Department Head

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* Have you notified your supervisor of your request for accommodation?

Yes

No

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* What type of accommodation are you requesting?

Medical Accommodation

Ergonomic Accommodation

Emotional Support Animal Accommodation